What you believe can have a big impact on how you feel. One attitude that has been well studied is "learned helplessness," which means thinking there's nothing you can do to help yourself. At the other end of the spectrum is "self-efficacy," which means thinking you have some control over your own life. A recent review of the medical literature (Rheumatic Diseases Clinics of North America, 1999) looked at several studies that have addressed these opposing viewpoints in people with rheumatoid arthritis. In the studies, learned helplessness was linked to higher levels of arthritis pain, depression, and disability, while self-efficacy was linked to less pain, depression, and disease activity.

Not-So-Great Expectations

It seems that when you expect the worst from arthritis, you often get it. Unfortunately, some people exaggerate the negatives about arthritis. Instead of looking at a situation realistically, they automatically blow the dark side out of proportion and overlook the bright side altogether. Such distorted thinking can lead to stress, depression, and anxiety, which makes arthritis pain harder to handle.

These are some common examples of distorted thinking:

• All-or-nothing thinking-Seeing things as black or white, with no shades of gray in-between. Let's say you're no longer able to do all the heavy household chores you once did. If you fall prey to this distortion, you might think, "If I can't mop the dirty floors, there's nothing useful I can do around the house."
• Over generalizing-Seeing a single negative event as one link in a never-ending chain of failure. In the example above, you might jump from being unable to do one task to thinking, "I'll never be able to do anything useful again."
• Mental filtering-Dwelling on a single negative detail until it colors your perception of the whole picture. Let's say you've gained 10 pounds since your last doctor's visit. You might focus on this until you convince yourself that the health news is awful, even though your arthritis pain and stiffness are under better control.
• Ignoring the positive-Rejecting positive events by insisting that they somehow don't count. For example, a friend says you look great on a day when your pain is worse than usual. Instead of being grateful that you don't look as bad as you feel, you immediately think, "She doesn't have a clue. I'm sure I must look terrible."
• Jumping to conclusions-Seeing a situation negatively, even though there are no facts to back up this view. Let's say you wake up with knee pain. You just "know" your whole day is going to turn out badly even before it really gets started.

Getting Real about Arthritis

If you've heard some of these thoughts bouncing around inside your own head, it may be time to reassess what you expect from arthritis. No, it's not a fun or easy experience, but it is one you can learn to accept realistically and manage effectively. With practice, you can learn to make your habitual thinking patterns work for you instead of against you, by replacing destructive thoughts with more constructive ones